Division of Cancer Surgery, Peter MacCallum Cancer Centre, Victorian Comprehensive Cancer Centre, Melbourne, Australia.
Department of Oncology, Sir Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Australia.
Int J Colorectal Dis. 2023 Jun 7;38(1):161. doi: 10.1007/s00384-023-04446-1.
Although several studies compare the clinical outcomes and costs of laparoscopic and robotic proctectomy, most of them reflect the outcomes of the utilisation of older generation robotic platforms. The aim of this study is to compare the financial and clinical outcomes of robotic and laparoscopic proctectomy within a public healthcare system, utilising a multi-quadrant platform.
Consecutive patients undergoing laparoscopic and robotic proctectomy between January 2017 and June 2020 in a public quaternary centre were included. Demographic characteristics, baseline clinical, tumour and operative variables, perioperative, histopathological outcomes and costs were compared between the laparoscopic and robotic groups. Simple linear regression and generalised linear model analyses with gamma distribution and log-link function were used to determine the impact of the surgical approach on overall costs.
During the study period, 113 patients underwent minimally invasive proctectomy. Of these, 81 (71.7%) underwent a robotic proctectomy. A robotic approach was associated with a lower conversion rate (2.5% versus 21.8%;P = 0.002) at the expense of longer operating times (284 ± 83.4 versus 243 ± 89.8 min;P = 0.025). Regarding financial outcomes, robotic surgery was associated with increased theatre costs (A$23,019 ± 8235 versus A$15,525 ± 6382; P < 0.001) and overall costs (A$34,350 ± 14,770 versus A$26,083 ± 12,647; P = 0.003). Hospitalisation costs were similar between both approaches. An ASA ≥ 3, non-metastatic disease, low rectal cancer, neoadjuvant therapy, non-restorative resection, extended resection, and a robotic approach were identified as drivers of overall costs in the univariate analysis. However, after performing a multivariate analysis, a robotic approach was not identified as an independent driver of overall costs during the inpatient episode (P = 0.1).
Robotic proctectomy was associated with increased theatre costs but not with increased overall inpatient costs within a public healthcare setting. Conversion was less common for robotic proctectomy at the expense of increased operating time. Larger studies will be needed to confirm these findings and examine the cost-effectiveness of robotic proctectomy to further justify its penetration in the public healthcare system.
虽然有几项研究比较了腹腔镜和机器人直肠切除术的临床结果和成本，但大多数研究反映的是使用旧一代机器人平台的结果。本研究的目的是在公共医疗体系内利用多象限平台比较机器人和腹腔镜直肠切除术的财务和临床结果。
纳入 2017 年 1 月至 2020 年 6 月在一家公立四级中心接受腹腔镜和机器人直肠切除术的连续患者。比较腹腔镜组和机器人组之间的人口统计学特征、基线临床、肿瘤和手术变量、围手术期、组织病理学结果和成本。使用简单线性回归和广义线性模型分析，采用伽马分布和对数链接函数，确定手术方法对总费用的影响。
在研究期间，113 名患者接受了微创直肠切除术。其中，81 名（71.7%）接受了机器人直肠切除术。机器人手术的转换率较低（2.5%比 21.8%；P=0.002），手术时间较长（284±83.4 比 243±89.8 分钟；P=0.025）。在财务结果方面，机器人手术与增加手术室成本相关（A$23019±8235 比 A$15525±6382；P<0.001）和总费用（A$34350±14770 比 A$26083±12647；P=0.003）。两种方法的住院费用相似。在单变量分析中，ASA≥3、非转移性疾病、低位直肠癌、新辅助治疗、非修复性切除术、扩大切除术和机器人方法被确定为总费用的驱动因素。然而，在进行多变量分析后，机器人方法在住院期间的总费用中未被确定为独立驱动因素（P=0.1）。
在公共医疗体系中，机器人直肠切除术与增加手术室成本相关，但与增加总住院费用无关。机器人直肠切除术的转换率较低，手术时间较长。需要更大的研究来证实这些发现，并检查机器人直肠切除术的成本效益，以进一步证明其在公共医疗体系中的渗透。
